PATHO SUMMARY

Nutcracker Esophagus

What is the esophageal disease caused by functional dysmotility?

Functional dysmotility

What is the etiology of Nutcracker Esophagus?

High amplitude contractions

What is the pathophysiology of Nutcracker Esophagus?

Distal esophagus

What is the structure affected in Nutcracker Esophagus?

High-pressure contractions with normal transit sequence

What is the distinguishing feature of Nutcracker Esophagus?

Non-cardiac chest pain

What is the primary complication of Nutcracker Esophagus?

Esophageal manometry

What procedure is used to assess Nutcracker Esophagus?

Normal Barium Swallow

What is a characteristic sign found in a Barium Swallow for Nutcracker Esophagus?

Manometry

What is the primary diagnostic for Nutcracker Esophagus?

Muscle relaxants or observation

What is the treatment for Nutcracker Esophagus?

Diffuse Esophageal Spasm (DES)

What condition is characterized by repetitive simultaneous, uncoordinated contractions?

Hypertrophy of muscle layers and vagus nerve degeneration

What is the etiology of Diffuse Esophageal Spasm?

Repetitive simultaneous, uncoordinated contractions

What is the pathophysiology of DES?

Entire esophageal length

What structures are affected by Diffuse Esophageal Spasm?

Corkscrew appearance

What is the distinguishing imaging feature of Diffuse Esophageal Spasm?

Dysphagia and retrosternal pain

What are the complications associated with DES?

Barium Swallow

What procedure is used to visualize the corkscrew appearance in DES?

Retrosternal pain worse with hot/cold liquids

What is a classic sign of Diffuse Esophageal Spasm?

Barium swallow or Manometry

What diagnostics are used for DES?

Medical management of spasm

What is the treatment for Diffuse Esophageal Spasm?

Zenker Diverticulum

What pathology is an outpouching due to impaired UES relaxation?

Increased intraluminal pressure (pulsion)

What is the etiology of Zenker Diverticulum?

Impaired UES relaxation

What specific pathophysiology leads to Zenker Diverticulum?

Immediately above the Upper Esophageal Sphincter (UES)

Where is Zenker Diverticulum located?

Accumulation of food in a neck cavity

What is the distinguishing feature of Zenker Diverticulum?

Regurgitation, halitosis, and infection

What are three complications of Zenker Diverticulum?

Endoscopy with caution

Which procedure must be performed carefully in Zenker Diverticulum to avoid perforation?

Mass-like symptoms in the neck

What is the physical sign of Zenker Diverticulum?

Barium swallow

What is the primary diagnostic for Zenker Diverticulum?

Surgical diverticulectomy

What is the definitive treatment for Zenker Diverticulum?

Benign Esophageal Stenosis

What disease involves fibrous thickening of the submucosa due to chronic GERD?

Chronic GERD, caustic injury, or inflammation

What are three causes of Benign Esophageal Stenosis?

Fibrous thickening of the submucosa and atrophy of muscularis propria

What is the pathophysiology of Benign Esophageal Stenosis?

Esophageal wall

What is the structure affected in Benign Esophageal Stenosis?

Progressive narrowing leading to structural obstruction

What is the distinguishing feature of Benign Esophageal Stenosis?

Permanent dysphagia

What is a major complication of Benign Esophageal Stenosis?

Dilation procedures

Which procedure is used to treat the narrowing in Benign Esophageal Stenosis?

Difficulty swallowing solids

What sign is typical for structural obstruction in Benign Esophageal Stenosis?

Endoscopy and Barium swallow

What are the two diagnostics used for Benign Esophageal Stenosis?

Endoscopic dilation

What is the primary treatment for Benign Esophageal Stenosis?

Esophageal Mucosal Webs

What condition involves semi-circumferential ledge-like protrusions in the upper esophagus?

Idiopathic, GERD, or Graft-versus-host disease

What is the etiology of Esophageal Mucosal Webs?

Semi-circumferential ledge-like protrusions

What is the pathophysiology of Esophageal Mucosal Webs?

Upper esophagus

Where are Esophageal Mucosal Webs typically located?

Plummer-Vinson Syndrome

Which syndrome features the triad of webs, anemia, and glossitis?

Non-progressive dysphagia

What is the complication of Esophageal Mucosal Webs?

Endoscopic rupture

What procedure can be used to treat Esophageal Mucosal Webs?

Cheilosis and glossitis

What are the signs of Plummer-Vinson Syndrome associated with webs?

Endoscopy

What diagnostic tool visualizes mucosal webs?

Dilation or treatment of anemia

What is the treatment for Esophageal Mucosal Webs?

Schatzki Ring

What is a circumferential mucosal thickening in the distal esophagus?

Hiatal hernia and GERD

What two conditions are associated with the etiology of Schatzki Ring?

Circumferential mucosal/submucosal thickening

What is the pathophysiology of a Schatzki Ring?

Distal esophagus or squamocolumnar junction

Where are Schatzki Rings located?

Thicker than webs and involves hypertrophic muscularis

How is a Schatzki Ring distinguished from a mucosal web?

Episodic food impaction

What is a major complication of Schatzki Rings?

Endoscopic dilation

What procedure is used to treat Schatzki Rings?

Solid food dysphagia

What sign is associated with Schatzki Rings?

Endoscopy

What is the primary diagnostic for Schatzki Rings?

Dilation

What is the treatment for Schatzki Rings?

Achalasia

What disease involves incomplete LES relaxation and increased LES tone?

Degeneration of nitric oxide-producing neurons

What is the etiology of Achalasia?

Incomplete LES relaxation, increased LES tone, and aperistalsis

What is the pathophysiology of Achalasia?

Lower Esophageal Sphincter (LES)

Which structure is the primary site of pathology in Achalasia?

Bird’s Beak sign

What is the classic Barium swallow finding for Achalasia?

Weight loss, aspiration, and increased cancer risk

What are three complications of Achalasia?

Laparoscopic myotomy

What surgical procedure is used for Achalasia?

Regurgitation of undigested food

What is a hallmark sign of Achalasia?

Manometry

What is the gold standard diagnostic for Achalasia?

Botox, dilation, or myotomy

What are three treatment options for Achalasia?

Mallory-Weiss Syndrome

What is a non-transmural linear mucosal laceration at the GE junction?

Forceful retching or vomiting

What is the etiology of Mallory-Weiss Syndrome?

Non-transmural linear mucosal laceration

What is the pathophysiology of Mallory-Weiss Syndrome?

Gastroesophageal junction or proximal stomach

Which structures are affected in Mallory-Weiss Syndrome?

Longitudinal tears crossing the GE junction

What is the distinguishing feature of Mallory-Weiss tears?

Upper GI Bleeding (Hematemesis)

What is the primary complication of Mallory-Weiss Syndrome?

Endoscopy

Which procedure is both a diagnostic and potential treatment for Mallory-Weiss Syndrome?

Fresh blood in vomitus

What is the classic sign of Mallory-Weiss Syndrome?

Endoscopic visualization

How is Mallory-Weiss Syndrome diagnosed?

Supportive or endoscopic clipping

What are the treatment options for Mallory-Weiss Syndrome?

Boerhaave Syndrome

What is a transmural rupture of the distal esophagus caused by severe retching?

Severe, persistent retching

What is the etiology of Boerhaave Syndrome?

Transmural rupture of the distal esophagus

What is the pathophysiology of Boerhaave Syndrome?

Distal esophagus

Where does the rupture occur in Boerhaave Syndrome?

Mistaken for Myocardial Infarction

What is a distinguishing feature of the presentation of Boerhaave Syndrome?

Mediastinitis, shock, and sepsis

What are the critical complications of Boerhaave Syndrome?

Emergency surgery

What procedure is required for Boerhaave Syndrome?

Severe chest pain, tachypnea, and shock

What are the signs of Boerhaave Syndrome?

CT scan or contrast study

What are the diagnostics for Boerhaave Syndrome?

Surgical repair

What is the treatment for Boerhaave Syndrome?

Chemical Esophagitis

What inflammation is caused by the ingestion of acidic or alkaline substances?

Accidental or suicidal ingestion

What is the etiology of Chemical Esophagitis?

Coagulative necrosis (acid) or protein lysis (alkali)

What is the pathophysiology of Chemical Esophagitis?

Esophageal and gastric mucosa

What structures are damaged in Chemical Esophagitis?

"Liquid Sosa" (alkali)

Which specific substance causes deeper penetration in Chemical Esophagitis?

Strictures and perforation

What are two major complications of Chemical Esophagitis?

Endoscopy (staged)

Which procedure is used to assess the severity of Chemical Esophagitis?

Odynophagia, hypersalivation, and mouth burns

What are the signs of Chemical Esophagitis?

Niguarda 90 Endoscopic Scale

Which diagnostic scale is used for Chemical Esophagitis?

Rehydration, antibiotics, and eventual dilation

What is the treatment plan for Chemical Esophagitis?